Human Gross Anatomy - Cases for Pelvis, Perineum, and Kidney

1. A 42
year old male presents with concerns of finding “bright red
blood in the toilet.” He denies any pain, burning, itching or
trauma to his rectum. Although this is the first time he has noted
blood that reddened the water he has seen blood on his toilet paper
before. He has never noted blood mixed with his stool. He denies
any diarrhea but has been more constipated recently.

What is
your differential diagnosis for this man’s symptoms?

If you
were to perform an anoscopy on this patient, what landmark would help
you differentiate the most likely causes of rectal bleeding?

2. A 62
year old female comes to your office with complaints of having
“accidents.” She initially had episodes of urinary
incontinence just when she would cough or sneeze but now is having
episodes with daily activities. She denies any dysuria, urgency or
frequency. She reports no abdominal or pelvic pain. She has full
sensation in her perineum and has had no episodes of fecal
incontinence. Her past medical history is only significant for early
osteoarthritis. Her gynecological history is remarkable for two
normal spontaneous vaginal deliveries and menopause at age 52 years.

What
are some of the possible anatomic mechanisms that would be
responsible for this patient’s symptoms?

What
treatment might you initially prescribe to help with this condition?

3. A 58
year old homeless man is brought into the emergency department
obtunded and febrile. The EMT’s accompanying him stated that
he was complaining of groin pain prior to becoming unresponsive. On
physical exam, the man appears ashen and does not respond to verbal
stimuli. He is febrile at 40.1 C, tachycardic with a pulse of 122
and weak, blood pressure was 70 over palp, and respirations were 32
per minute. His perineum is erythematous, edematous and has areas of
necrosis that extends on to his scrotum, which is massively enlarged.

What
general process is occurring in this gentleman and what do you
believe the appropriate treatment might be?

What
might be the potential complications of this process given the
anatomic location?

A 28
year old female presents to your office with complaints of abdominal
pain and bloating. It began approximately three days prior and has
been worsening in intensity. The pain is generalized, colicky in
nature, non-radiating, without associated vomiting. She has been
nauseated the last 24 hours. She reports no bowel movement for 6
days. She denies weight loss. She denies pregnancy but states that
she hasn’t had her menses for the last 6 months. On physical
exam, the patient is a frail appearing young female with mild
abdominal distention who was in mild distress, assuming the fetal
position. The abdomen was tympanitic with scant bowel sounds that
were occasionally high pitched. There were no peritoneal signs
present.

What
is your differential diagnosis for this patient’s symptoms?
What part of the physical exam do you want to perform at this point?

What
are some of the potential anatomic mechanisms for
constipation/obstipation?

A 32
year old very distraught female comes to your office with complaints
of fecal incontinence. Every since the delivery of her second child
she has noted that her ability to control her bowel movements has
been compromised. On pelvic exam, she has normal sensation to the
perineum and associated structures. No rectocele is present.
However, her rectal exam displays poor anal sphincter tone.

What
may have been the etiology of this patient’s stool
incontinence? What anatomic structures were likely damaged in this
process?

What
might be the potential treatment(s) for this patient’s
condition and potential complications?